Christine Jordan Sexton
As the 2023 Legislative Session draws nearer to an end, the Senate passed a bill (SB 1550) that “attacks” pharmacy benefit managers (PBMs) and is a top priority for Gov. Ron DeSantis.
“When you go home this summer and want to talk about something that you really did for everybody back home, this is going to be one of the good ones,” bill sponsor Sen. Jason Brodeur said prior to the unanimous vote to pass the bill.
Sen. Gayle Harrell heaped praise on the bill and Brodeur’s work on it.
“This is finally, again, another bill many, many years in the works that’s finally coming to fruition. For patients, I can’t tell you what a difference this is going to make in transparency, in the ability to get their prescriptions, where they choose to get them. And for pharmacists, our everyday local pharmacy, who is going to be able to not have various customers turned away or sent to, steered, to other chain pharmacies,” Harrell said.
“This is a major, major, endeavor that took a lot of working, putting a lot of people, again, in the same room working through things. And it is now going to really bring transparency to the price of prescriptions and every single patient will benefit. Thank you, thank you, thank you.”
To Harrell’s point, the Legislature has wrestled with the proper amount of PBM regulation over the years. But until now the Governor’s Office has not been involved in the debate. DeSantis instead focused his efforts on pursuing a Canadian drug importation program.
Florida’s request to import drugs has not been approved by the federal government. DeSantis, who is expected to announce his plans to enter the Republican Presidential Primary, announced in January his plans to crack down on PBMs and give residents more control over their pharmacy benefits.
Brodeur on Wednesday initially said that, through the bill, the state is “attacking” the PBM industry, then added, “or at least trying to put some guardrails on.”
The bill has pitted the PBM industry against pharmaceutical manufacturers and pharmacy interests, with the groups exchanging poll data alleging support for their positions. And the camps have released contradictory poll findings.
A poll conducted by Lake Research Partners and Bellwether Research found more than three-quarters of likely voters are concerned about the impact pharmacy benefit managers have on drug prices, while 84% believe they should be required to provide value and lower costs.
Meanwhile, a poll conducted on behalf of Floridians for Government Accountability showed 75% of all respondents — and 90% of seniors — in opposition to the bills.
The group EMPOWER Patients. also praised Brodeur for the legislation.
“This is a momentous milestone for both patients and independent and community pharmacists, as we are now one step closer to implementing meaningful pharmacy benefit manager reform in Florida,” said Helen Sairany, Executive Vice President and CEO of the Florida Pharmacy Association and EMPOWER Patients coalition member.
A staff analysis indicates that some of the bill’s provisions may prohibit PBMs from “employing mechanisms designed to reduce costs of prescription drugs for insurers, HMOs, and other pharmacy benefits plans and programs, which could have the effect of increasing premiums and/or other costs for such payers or for persons with individual coverage. The extent of such an effect is indeterminate.”
The analysis estimates that the provisions, which apply to the state group health insurance program, will increase the costs of that benefit plan by as much as $2.2 million. Due to those cost concerns, the Senate tagged on an amendment to make clear that the provisions of the PBM don’t provide workers’ compensation.
PBMs are referred to as the middle men in the pharmacy chain. They work on behalf of insurance companies and employers and negotiate discounts on behalf of their customers.
The bill also requires PBMs to obtain a certificate of authority for an administrator with the state insurance department.
The bill requires PBMs to pass on 100% of all manufacturer rebates they receive to the plan or program if the contractual arrangement delegates rebate negotiations to PBMs for the sole purpose of offsetting defined cost sharing and reducing premium costs. Medicaid managed care plans are exempt from the requirement because those rebates are returned to the state.
Drug manufacturers will be required to disclose reportable prescription drug price increases so the state can publish them on a website. Drugs that cost $100 or more for a course of treatment are defined as reportable.
For reportable drugs, the bill requires the manufacturers to report any increase of 15% or more of the wholesale acquisition cost over the past 12 months; or any increase of 30% or more of the wholesale acquisition cost over the past three calendar years.
